Continuous intravenous infusion of isoproterenol was employed in 20 episodes of status asthmaticus in 16 children whose Paco2 was > 55 torr (mean 71 torr) despite conventional therapy. In 18 episodes (14 patients), there was a prompt and sustained mean reduction in Paco2 of 16 torr after an average of only 1.7 hr; after an average of 10 hr infusion the mean Paco2 reached 42 torr. The average A-aO2 at Fio2 0.50 was not significantly affected, although four patients incurred a transient fall in Pao2. The mean peak dose was 0.80 μg/kg/min, and the duration of infusion averaged 45 hr. Mechanical ventilation was obviated in these 14 patients. Two patients did not experience a beneficial response. We conclude that in children with status asthmaticus and severe hypercapnia, infusions of isoproterenol: 1) reduce the incidence of respiratory failure requiring mechanical ventilation, 2) shorten the duration of severe hypercapnia, 3) are attended by relatively few yet potentially serious complications, and 4) deserve extensive clinical trial.
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Downes et al. (1973) studied this question.